MEDICARE: JONATHAN HOOD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1376132472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN HOOD

Provider Business Mailing Address
First Line	:	3650 MORNING STAR DR UNIT 3604
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-1782
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 MORNING STAR DR UNIT 3604
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-1782
Country	:	US
Telephone Number	:	469-237-7567
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2021
Last Update Date	:	01/13/2021

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Directions to “ JONATHAN HOOD ” Practice Location

Language	Start Address	Practice Location

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